Daily Habits & Attitudes

Before you begin the Come Alive! Small Group Program, please complete the following Come Alive! Daily Habits & Attitudes Pre-Program Assessment. We ask you to thoughtfully and honestly consider your answers.Your assessment responses will uniquely represent you at this point in time. (There’s no need to compare your results with others.) After submitting the test, please print a copy of the results for you to keep.At the end of the Come Alive! program, you will be given directons by your facilitator to complete the Come Alive! Daily Habits & Attitudes Post-Assessment. After taking the post assessment, you cancompare your responses to each question in the Pre-Asseement to the Post-Assessment. Comparing your answers will help you understand how your daily rhythms, attitudes, and habits are changing.

* First name

* Last name

* Email address

Phone number (optional)

* City

* State

Small Group Name (optional)

* How I Look at ThingsCheck the box that most closely describes how you feel most of the time

Almost Always (4)

Often (3)

Sometimes (2)

Seldom (1)

Almost Never (0)

1. I feel my life has purpose and value

2. I have a positive outlook toward life

3. I trust that God is working in my life

4. My faith is an important priority for me

5. I am aware of and grateful for God's creation and people

6. I am aware of the rhythm of my day

7. I am satisfied with the balance in my life (Spiritual, Physical Health & Relationships)

8. I am content with my life

9. I am satisfied with my level of energy

10. I am satisfied with the way my body functions for daily activities of living

11. I am satisfied with my physical health

12. I usually wake up feeling rested

13. I am able to focus and think clearly

If you'd like to know your score in the How I Look At Things category, add the Numeric Values of Questions 1-13 and enter the subtotal here:

* My Relationship With OthersCheck the box that most closely describes how you feel most of the time

Almost Always (4)

Often (3)

Sometimes (2)

Seldom (1)

Almost Never (0)

1. I listen and respond to others with understanding

2. I freely receive support from others

3. I ask for help when I need it

4. I am part of a Christian community that supports me

5. I pray for others

6. I would like my church to support me in my efforts to care for my body

7. My church intentionally supports my efforts to care for my body

If you'd like to know your score in the My Relationship With Others category, add the Numeric Values from Questions 1-7 and enter the subtotal here:

* What I've Noticed LatelyPLEASE NOTE! THE ANSWER WORDING & VALUES FOR THIS SECTION ARE REVERSED

Almost Never (4)

Seldom (3)

Sometimes (2)

Often (1)

Almost Always (0)

1. I have too much to do and I am pressed for time

2. I feel anxious

3. I feel down or depressed

4. I feel stressed

5. I have difficulty falling asleep

If you'd like to know your score in the What I've Noticed Lately category, add the numeric values from questions 1-5 and enter the subtotal here:

* My Level of ConfidencePLEASE NOTE! THE CHANGE IN ANSWER WORDING & VALUES IN THIS SECTION

Almost Always (4)

Often (3)

Sometimes (2)

Seldom (1)

Almost Never (0)

1. I feel confident in my ability to seek God first as I live my life

2. I feel confident in my ability to give care and love to others

3. I feel confident in my ability to let others give me care and love

4. I feel confident that I know which food choices reduce inflammation and improve my health

5. I feel confident in my ability to make healthy food choices most of the time

6. I feel confident in my ability to be physically active most days

If you'd like to know your score in My Level of Confidence category, add the numeric values from questions 1-6 and enter the subtotal here:

* Is your Blood Pressure at or below the average healthy blood pressure of 120/80?

Yes

No

I don't know

* Do you currently smoke cigarettes, cigars, pipes or use chewing tobacco?

Yes

No

My Goals:

What are your top 3 goals for the Come Alive! program & why? (Please be as specific as possible.)

* 1.

* 2.

* 3.

* Are there any barriers you believe may hold you back from reaching your goals? Please describe.

* Rank the 11 topics below in order of importance to you (click hold and drag your most important topic from the left box into the right box, then repeat with topic #2 and so on.You may change the order of the topics in the right box by click hold and dragging them up or down in the right box)

Strengthen my relationship with God

Learn what the Bible says about physical health

Improve my relationships with others

Make new friends

Have fun

Learn more about myself

Increase my energy level

Lose weight

Create healthy habits to improve my health

Learn how to move more

Manage a chronic health condition or disease

1

2

3

4

5

6

7

8

9

10

11

Strengthen my relationship with God

Learn what the Bible says about physical health

Improve my relationships with others

Make new friends

Have fun

Learn more about myself

Increase my energy level

Lose weight

Create healthy habits to improve my health

Learn how to move more

Manage a chronic health condition or disease

Please tell us about yourself:

* What is your gender?

Female

Male

Other

* In what range does your age fall?

Under 17 years old

18-24 years old

25-29 years old

30-39 years old

40-49 years old

50-59 years old

60-69 years old

70 or more years old

* Which of the following best describes your ethnicity?

Asian

Black or African American

Hispanic

Native American or Alaska Native

Native Hawaiian or Other Pacific Islander

White or Caucasian

Other

Prefer not to answer

* What category best describes you?

Employed full-time (40 hours or more per week))

Employed part-time (39 hours or less per week)

Self-employed

Student

Homemaker

Retired

Unemployed

Unable to Work or Disabled

* What is the highest level of education you have completed?

Some high school

High school graduate/GED

Some college

2-year College Degree (Associate's Degree)

4-year College Degree (Bachelor's Degree)

Master Degree

Doctoral Degree (PhD)

* How many children do you have under the age of 18 and living in your household?

0

1-2

3-4

5 or more

Click "Finish Survey". Then print your assessment by putting your curser at the top of the screen over "File" and then choose "Print" from the drop down choices. The survey will be 8 pages long.If you have issues printing, please email angela@livingabundantlyministries.org for assistance.